1184845844 NPI number — TYMON C TOTTE

Table of content: TYMON C TOTTE (NPI 1184845844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184845844 NPI number — TYMON C TOTTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOTTE
Provider First Name:
TYMON
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184845844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E LONG LAKE RD
Provider Second Line Business Mailing Address:
STE 311
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-203-1119
Provider Business Mailing Address Fax Number:
248-723-0052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17700 MACK AVE
Provider Second Line Business Practice Location Address:
GREAT EXPRESSIONS DENTAL CENTERS
Provider Business Practice Location Address City Name:
GROSS POINTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-882-2211
Provider Business Practice Location Address Fax Number:
313-882-5434
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901018712 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)